Mallon in 1909
|Died||November 11, 1938 (aged 69)|
Riverside Hospital, North Brother Island, New York, U.S.
|Resting place||Saint Raymond's Cemetery, The Bronx, New York, U.S.|
|Known for||Asymptomatic carrier of typhoid fever|
Mary Mallon (September 23, 1869 – November 11, 1938), also known as Typhoid Mary, was an Irish-born cook believed to have infected 53 people, three of whom died, with typhoid fever, and the first person in the United States identified as an asymptomatic carrier of the disease. Because she persisted in working as a cook, by which she exposed others to the disease, she was twice forcibly quarantined by authorities, and died after a total of nearly three decades in isolation.
Mary Mallon was born in 1869 in Cookstown, County Tyrone, in what is now Northern Ireland. Presumably, she was born with typhoid because her mother was infected during pregnancy. At the age of 15, she migrated to the United States. She lived with her aunt and uncle for a time and worked as a maid, but eventually became a cook for affluent families.
From 1900 to 1907, Mallon worked as a cook in the New York City area for eight families, seven of which contracted typhoid. In 1900, she worked in Mamaroneck, New York, where within two weeks of her employment, residents developed typhoid fever. In 1901, she moved to Manhattan, where members of the family for whom she worked developed fevers and diarrhea, and the laundress died. Mallon then went to work for a lawyer and left after seven of the eight people in that household became ill.
In June 1904, she was hired by a prosperous lawyer, Henry Gilsey. Within a week, the laundress was infected with typhoid, and soon four of the seven servants were ill. No members of Gilsey's family were infected, because they resided separately, and the servants lived in their own house. The investigator Dr. R. L. Wilson concluded that the laundress had caused the outbreak, but he failed to prove it. Immediately after the outbreak began, Mallon left and moved to Tuxedo Park, where she was hired by George Kessler. Two weeks later, the laundress in his household was infected and taken to St. Joseph's Regional Medical Center, where her case of typhoid was the first in a long time.
In August 1906, Mallon took a position in Oyster Bay on Long Island with the family of a wealthy New York banker, Charles Henry Warren. Mallon went along with the Warrens when they rented a house in Oyster Bay for the summer of 1906. From August 27 to September 3, six of the 11 people in the family came down with typhoid fever. The disease at that time was "unusual" in Oyster Bay, according to three medical doctors who practiced there. The landlord, understanding that it would be impossible to rent a house with the reputation of typhoid, hired several independent experts to find the source of infection. They took water samples from pipes, faucets, toilets, and the cesspool, all of which were negative for typhoid.
In late 1906, Mallon was hired by Walter Bowen, whose family lived on Park Avenue. Their maid got sick on January 23, 1907, and soon Charles Warren’s only daughter got typhoid and died. This case helped to identify Mallon as the source of the infections. George Soper, an investigator hired by Warren after the outbreak in Oyster Bay, had been trying to determine the cause of typhoid outbreaks in well-to-do families, when it was known that the disease typically struck in unsanitary environments. He discovered that a female Irish cook, who fit the physical description he had been given, was involved in all of the outbreaks. He was unable to locate her because she generally left after an outbreak began, without giving a forwarding address. Soper then learned of an active outbreak in a penthouse on Park Avenue and discovered Mallon was the cook. Two of the household's servants were hospitalized, and the daughter of the family died of typhoid.
Soper first met Mallon in the kitchen of the Bowens and accused her of spreading the disease. Though Soper himself recollected his behavior as "as diplomatic as possible", he infuriated Mallon and she threatened him with a carving fork. When Mallon refused to give samples, Soper decided to compile a five-year history of her employment. He found that of the eight families that had hired Mallon as a cook, members of seven claimed to have contracted typhoid fever. Then Soper found out where Mallon's lover lived and arranged a new meeting there. He took Dr. Raymond Hoobler in an attempt to convince Mary to give them samples of urine and stool for analysis. Mallon again refused to cooperate, believing that typhoid was everywhere and that the outbreaks had happened because of contaminated food and water. At that time, the concept of healthy carriers was unknown even to healthcare workers.
It was found that the family changed cooks on August 4. This was about three weeks before the typhoid epidemic broke out. The new cook, Mallon, remained in the family only a short time and left about three weeks after the outbreak occurred. Mallon was described as an Irish woman about 40 years of age, tall, heavy, single. She seemed to be in perfect health.
First quarantine (1907–1910)
Soper notified the New York City Health Department, whose investigators realized that Mallon was a typhoid carrier. Under sections 1169 and 1170 of the Greater New York Charter, Mallon was arrested as a public health threat. She was forced into an ambulance by five policemen and Dr. Josephine Baker, who at some point had to sit on Mallon to restrain her. Mallon was transported to the Willard Parker Hospital, where she was restrained and forced to give samples. For four days, she wasn't even allowed to get up and use the bathroom on her own. The massive amounts of typhoid bacteria that were discovered in her stool samples indicated that the infection center was in her gallbladder. Under questioning, Mallon admitted that she almost never washed her hands. This was not unusual at the time; the germ theory of disease still was not fully accepted.
On March 19, 1907, Mary was sentenced to quarantine on North Brother Island. While quarantined, she gave stool and urine samples three times per week. Authorities suggested removing her gallbladder, but she refused because she did not believe she carried the disease. At the time, gallbladder removal was dangerous, and people had died from the procedure. Mallon was also unwilling to stop working as a cook, a job that earned her more money than any other. Having no home of her own, she was always on the verge of poverty.
After Soper's publication in the Journal of the American Medical Association, Mary attracted extensive media attention and received the nickname "Typhoid Mary". Later, in a textbook that defined typhoid fever, she again was called "Typhoid Mary"
Soper visited Mallon in quarantine, telling her he would write a book and give her part of the royalties. She angrily rejected his proposal and locked herself in the bathroom until he left. She hated the nickname and wrote in a letter to her lawyer:
I wonder how the said Dr. William H. Park would like to be insulted and put in the Journal and call him or his wife Typhoid William Park.
Not all medical experts supported the decision to forcibly quarantine Mallon. For example, Milton J. Rosenau and Charles V. Chapin both argued that she just had to be taught to carefully treat her condition and ensure that she would not transmit the typhoid to others. Both considered isolation to be an unnecessary, overly strict punishment. Mallon suffered from a nervous breakdown after her arrest and forcible transportation to the hospital. In 1909, she tried to sue the New York Health Department, but her complaint was denied and the case closed by the New York Supreme Court. In a letter to her lawyer, she complained that she was treated like a "guinea pig". She was obliged to give samples for analysis three times a week, but for six months was not allowed to visit an eye doctor, even though her eyelid was paralyzed and she had to bandage it at night. Her medical treatment was hectic: she was given urotropin in three-month courses for a year, threatening to destroy her kidneys, then changed to brewers yeast and hexamethylenamin in increasing doses. She was first told that she had typhoid in her intestinal tract, then in her bowel muscles, then in her gallbladder.
Mallon herself never believed that she was a carrier. With the help of a friend, she sent several samples to an independent New York laboratory. All came back negative for typhoid. On North Brother Island, almost a quarter of her analyses from March 1907 through June 1909 were also negative. After 2 years and 11 months of Mallon's quarantine, Eugene H. Porter, the New York State Commissioner of Health, decided that disease carriers should no longer be kept in isolation and that Mallon could be freed if she agreed to stop working as a cook and take reasonable steps to avoid transmitting typhoid to others. On February 19, 1910, Mallon said she was "prepared to change her occupation (that of a cook), and would give assurance by affidavit that she would upon her release take such hygienic precautions as would protect those with whom she came in contact, from infection." She was released from quarantine and returned to the mainland.
Release and second quarantine (1915–1938)
Upon her release, Mallon was given a job as a laundress, which paid less than cooking — only 20 dollars per month instead of 50. At some point she wounded her arm, the wound became infected, and she could not work at all for six months. After several unsuccessful years, she started cooking again. She used fake surnames like Breshof or Brown and took jobs as a cook against the explicit instructions of health authorities. No agencies that hired servants for upscale families would offer her employment, so for the next five years she moved to the mass sector. She worked in a number of kitchens in restaurants, hotels, and spa centers. Almost wherever she worked, there were outbreaks of typhoid. However, she changed jobs frequently, and Soper was unable to find her.
In 1915, Mallon started working at Sloane Hospital for Women in New York City. Soon 25 people were infected, and two died. The head obstetrician, Dr. Edward B. Cragin, called Soper and asked him to help in the investigation. Soper identified Mallon from the servants' verbal descriptions and also by her handwriting.
Mallon again fled, but the police were able to find and arrest her when she took food to a friend on Long Island. Mallon was returned to quarantine on North Brother Island on March 27, 1915.
Little is known about her life during the second quarantine. She remained on North Brother for more than 23 years; the authorities gave her a private one-storey cottage. As of 1918 she was allowed to take day trips to the mainland. In 1925, Dr. Alexandra Plavska came to the island for an internship. She organized a laboratory on the second floor of the chapel and offered Mallon a job as a technician. Mallon washed bottles, did recordings, and prepared glasses for pathologists.
Mallon spent the rest of her life in quarantine at Riverside Hospital on North Brother Island. Six years before her death, she had a stroke. Mary Mallon never completely recovered, and half of her body remained paralyzed. On November 11, 1938, she died of pneumonia at age 69. Mallon's body was cremated, and her ashes were buried at Saint Raymond's Cemetery in the Bronx. Only nine people attended the funeral.
Some sources claim that a post-mortem found evidence of live typhoid bacteria in Mallon's gallbladder. Soper wrote, however, that there was no autopsy, a claim cited by other researchers to assert a conspiracy to calm public opinion after her death.
At least three deaths were attributed to Mallon, but because of her use of aliases and refusal to cooperate, the exact number is not known. Some have estimated that she may have caused 50 fatalities.
Other healthy typhoid carriers identified in the first quarter of the 20th century include Tony Labella, an Italian immigrant, presumed to have caused over 100 cases (with five deaths); an Adirondack guide dubbed "Typhoid John", presumed to have infected 36 people (with two deaths); and Alphonse Cotils, a restaurateur and bakery owner.
The 1910s medicine could not offer 100% effective solution — there were no antibiotics to fight the infection; and gallbladder removal was a dangerous, sometimes fatal operation. Some modern specialists claim that the typhoid bacteria can hide in macrophages and then hide in the intestinal lymph nodes or spleen.
Ethical and Legal Issues
Mallon's case became the first in which an asymptomatic carrier was discovered and forcibly isolated. The ethical and legal issues raised by her case are still discussed. Personal rights and liberty were balanced for the sake of public health.
Today, the phrase "Typhoid Mary" is a colloquial term for anyone who, knowingly or not, spreads disease or some other undesirable thing.
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Mary Mallon, the first carrier of typhoid bacilli identified in America and consequently known as Typhoid Mary, died yesterday in Riverside Hospital on North Brother Island.
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